Healthcare Provider Details

I. General information

NPI: 1669394169
Provider Name (Legal Business Name): MAIYA NICHOLE SARGENT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/27/2026
Last Update Date: 07/27/2026
Certification Date: 07/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

321 E NORTHFIELD DR STE 100
BROWNSBURG IN
46112-2415
US

IV. Provider business mailing address

712 CRYSTAL FARMS DR
AVON IN
46123-8301
US

V. Phone/Fax

Practice location:
  • Phone: 131-774-2902
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number9370058050
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: